Dr. Paul M. Pearce, MD

Finger reattachment is a complex microsurgical procedure. If reattachment is possible, patients can expect a long time in the operating room, often requiring a Foley catheter. The process involves reattaching bones with pins, then repairing tendons (Dr. Pearce prefers the modified Kessler approach), and finally using a surgical microscope with sutures thinner than a human hair to fix tiny blood vessels. Dr. Pearce notes that fixing veins is particularly challenging, often necessitating the use of leeches for 4-5 days post-op until natural venous return establishes. A 2-4 day ICU stay is typically required, which is a significant cost factor.

Dr. Pearce strongly recommends always using face protection when operating tools like an angle grinder. He emphasizes that face protection serves as the critical last line of defense against severe facial injuries that could otherwise lead to an ICU stay and require a breathing tube.

For breast lift scars, Dr. Pearce recommends starting basic preventative treatments about three weeks after surgery. Patients are advised to use silicone scar sheets, specifically the Cylogen brand, for approximately three months. These sheets and gels work by keeping the scar hydrated, which promotes collagen production, reduces redness, and helps create a smoother scar. While most scars fade significantly over 12-18 months naturally, consistent use of silicone strips can help them fade to almost nothing. After three months of silicone use, patients are typically advised to wait until about the one-year mark before considering other scar treatments.

The cost and surgical approach for gynecomastia depend on several factors, including the extent of the condition and patient preference. Mild to moderate cases involving glandular tissue or liposuction can often be performed in the office under local anesthetic, starting around $5,000 at this practice. This in-office approach helps reduce the overall price by avoiding facility and general anesthesia fees. However, for more extensive cases, such as significant loose skin after weight loss, or if a patient prefers not to be awake, surgery in an operating room is recommended for safety and will increase the cost. Additional factors like age and the need for skin tightening (e.g., using J-Plasma) can also increase the price. Overall, prices for gynecomastia surgery can range from approximately $5,000 up to $15,000, varying by surgeon and region.

Breast implants, whether saline or silicone, will not freeze rock-solid in a living person. Saline implants would require a core body temperature of around 28°F, and silicone implants between -67°F and -170°F, neither of which is survivable. However, implants can be slower to adjust to temperature changes than the rest of the body. For example, after being in a cold swimming pool or spending time outside in the cold, implants might feel cold for a while. This effect can be more noticeable if implants are placed above the muscle, where there's less insulation, compared to behind the muscle where blood flow helps keep them warmer.

Pseudo-gynecomastia refers to chest fat that can improve with diet and exercise, especially if the chest feels soft and lacks a hard, rubbery lump. True gynecomastia, however, is caused by thick, fibrous glandular tissue that will not respond to diet and exercise. The only effective treatment for true gynecomastia is surgery, which involves a small incision around the areola to remove the gland, resulting in a much better chest shape. Dr. Pearce advises attempting diet and exercise first, as there's no way to definitively know if it's pseudo-gynecomastia until you try.